Tuesday, December 13, 2011

"Health Is Politics By Other Means" (ASA 2011)

The seventh in a series of reports from the American Studies Association.

"Repairing the Body Politic: Race, Health, and Justice."

Moderator Nanlesta Pilgrim thanked everyone for having come in spite of the fact that the conference program listed the panel as being in a nonexistent room. Headliner Alondra Nelson thanked everybody for having come in spite of the fact that the panel was occurring simultaneously with Angela Davis’s panel.

Much of Nelson’s talk was derived from parts of her Body and Soul: The Black Panther Party and the Fight against Medical Discrimination. Her thesis is that health is politics by other means. This point is evident in, for example, Bill Clinton’s having commemorated the tenth anniversary of the decoding of the human genome by speaking of how that accomplishment demonstrated “our common humanity”; it is also clear from the recent battle over the Patient Protection and Affordable Care Act. Health is associated with the Good Society. Battles over health policy, from the fight between right-wing accusations leveled at “Obamacare” and assertions of the right to health to bigger issues of state power and business influence associated with the PPACA, showed how discussion of healthcare is a medium through which major political differences are expressed.

The Black Panther Party is not remembered for health activism. But Huey Newton and Bobby Seale sought to protect black communities using that activism, working for medical self-defense: for example, the Party-led movement against the UC Center for the Study of Violence was an instance of the Panthers protecting the community from medical experimentation. The Party consistently fought against medical abuse, real and imagined. Their newsletter published a fascinating report on the discovery of the Tuskegee experiment. And their 1972 “Black Community Survival Conference: Serving the People Body and Soul” included barbecue, voter registration drives, and health initiatives. Detractors have claimed that that conference and its successors marked the deradicalization of the Party, but health activism was part of the Party’s radical tradition. Newton and Brown revised Point Six of the Party’s platform to demand free health care for all black and oppressed peoples.

As the mid-Sixties civil rights struggles’ spotlight moved North, the movement more stridently projected health as a locus of struggles for political equality. Dr. King said, “Of all forms of inequality, injustice in health care is the most shocking and inhumane.” The Party’s call for health care was indebted to the World Health Organization and shared that institution’s definition of health; it also built on traditions in Left and African-American thought associating health with social well-being. The struggle for health access was a signpost in the Long Civil Rights Movement. Nelson explores the ideological, tactical, and historical contexts responsible for the growth of health activism: ideologically, the Party drew on ideas from Mao, Che, and Fanon; tactically, it instituted a series of People’s Free Medical Centers, many — like the Bunchy Carter Free Clinic in L.A.— named for Party martyrs; and many, like that clinic, short-lived because they were attacked and ransacked by police.

Although the Party’s Sickle-Cell Anemia Research Foundation never got off the ground, they did offer genetic screening programs for sickle-cell anemia as well as health education outreach with media appearances, pamphlets, and the like and a series of editorials from 1971 to 1974. During the week that they hosted the Mike Douglas Show in 1973, John Lennon and Yoko Ono had Party affiliates on discussing the Sickle Cell Anemia campaign. It’s taken a lot of historical erasure to obliterate such activism from our memories. The black community has been both underserved by and overexposed to the medical establishment. The Party’s history shows that it was not anti-medicine — “they didn’t want to chuck out medicine wholesale” — but they wanted some control over what medicine did and where and to whom. As we hear in recent years about the Henrietta Lacks case, about the Guatemala syphilis case, about all these events that compound the record of uneven encounters between minority populations and medicine; as we read books like Medical Apartheid and study racial health disparities, learning the basis for black distrust of the medical system, we have to realize that people of color have played other roles than that of its victims: Harriet Washington thinks shining a light on past injustices would help us, but so will the recovery work that reminds us of black agency in the health care struggle.

Catherine Bliss spoke of “Science and Struggle: Biomedical Research as Activism.” There’s a press photo from around 2000 of Bill Clinton with Francis Collins and other researchers celebrating the human genome project and talking about what unites “all human beings, regardless of race . . . ,” implying that scientific research on race and the use of racial boundaries are no longer justified by science. We’ve seen a deluge of studies, research solutions to heal the body politic by addressing the social issue of race. But somehow genomics became the new science of race. Bliss interviewed thirty-six members of the professional elite and discovered a new activism, using tactics of the New Left era (which included the medical civil rights movement): as genomics followed the post-Civil Rights Era, and began enacting these tactics to further research goals. Thus scientists are allying themselves with progressive movements by borrowing their tactics, but how they’re deployed is limited by the pragmatics of the field: genomics is Big Science, tied closely to private industry.

Hence leading genomicists use the language of Left consciousness-raising when they talk about addressing “the lay community.” To the scientists, this means they have a responsibility to create awareness, which they do through discussing sequencing projects. So they reframe the building of consciousness as individual actions for private gains, not as challenging the built environment and the social structure. They talk about integration and use it to mean research-inclusion: it doesn’t give minorities access to health care, just to unproven therapies. And in their hands, strategic essentialism means reifying groupness to gain resources for the group in question — it deploys international and minority scientists, invoking the rhetoric of self-determination, and scientists feel that they’re helping minorities without actually challenging the status quo or contesting the categories such people are placed in. And upholding self-determination is only used in collecting data and recording it.

There’s a real interest in social justice, but it’s manifested as a consciousness-raising that promotes essentialism, enhances expert power, and creates permanent structures of racialized science. Dividing populations into the categories “Europe”, “Africa”, and “Japan”, for example, reifies strategic essentialism and self-representation. Even more dangerous is the co-optation of access: the scientists say “access” and mean new markets for drugs. In short, the professional elites are unchanging agents of change, whose practices have harmful material consequences. We need to move away from “the word-heft of ‘race’ into how best to care for patients”; we have to be concerned about how biomedical science could be (and is) mobilized for a deepening of racial difference in society.

Sean Greene, with the moderator’s encouragement, spoke at great length on “Saving King/Drew: Black Activism, Health Care, and the Future of South L.A.”: Pilgrim was not interested in enforcing time limits, so the whole panel, with the q & a included, extended into the time frame for the next set of panels (no one else had reserved the room for that time frame, so it's not as if any other panel was hurt). Greene’s topic was the struggle to preserve, reform, and reopen the King/Drew medical center in the context of the struggle over resources in South L.A., and how proponents of the center managed to build support for the center in the political climate of the last decade. The struggle shifted public debate from a rhetoric of crisis to one of reinvention/reform. It highlights the efforts of people of color to re-envision and remake disintegrating formerly industrial neighborhoods.

The prehistory of King/Drew goes back to the black hospital movement so well-documented by Vanessa Gamble but starts in earnest after WWII. In 1947 black physicians tried to create a nonprofit, nonsectarian interracial hospital in the area; there were many efforts in the 1950s to start one, with the support of such celebrities as Joe Louis; but nobody could raise the funds. A proposal in 1963 was denied on the grounds that L.A. had enough hospitals. Many physicians in times of segregation saw black hospitals as their best hopes. The Watts uprising of 1965 changed the balance: the McComb commission in listing the causes of the riots included a lack of access to health care and addressed the problem of the “Five Dollar Sick.” One of the demands that then arose in the wake of the riots was the creation of a hospital to serve the community — because it was a Movement project, self-determination and community control were central. King/Drew and analogous institutions constituted a partial fulfillment of postwar aspirations for black empowerment and community development: the hospital reflected one of the few successful post-Watts demands.

But by the end of the century, the public ground on which the hospital had been built was shrinking. People of color were fighting harder for less and less. The area had changed, becoming majority-Latino. And shifts in staffing and services were required in a time of ever-shrinking resources. The L.A. Times’s 2004 series of exposés of King-Drew revealed egregious medical mistakes and horror stories, arguing that they’d arisen from lack of oversight, corruption, and poor administration, claiming that fear and the soft bigotry of low expectations had hitherto prevented criticism of the hospital. The articles tried to argue that King-Drew was adequately funded but still spectacularly bad. In response to the reports, supervisors got heads rolling and hired eighteen million dollars’ worth of private consultants. Many in the community saw the agenda as dismantling and privatizing the institution. Many specialty units closed their doors — the ending of Ob/Gyn services in particular led to an uprising in the community. The agents of this dismantling were at the federal level and on the accreditation boards, and they’d been working on it for a while: a number of residency programs had been closed or put on probation before the LAT’s articles appeared. The general sentiment was that the hospital might be salvageable if it shrunk. Organizations to maintain the hospital arose in the community — Save King/Drew included some of the hospital’s founders and saw community leaders and activists allied with political officials. But in four years, King-Drew was reduced to an outpatient clinic. Often activists would contest the idea that the way to address the problems was to leave the area without medical resources. Activists were demonized or caricatured in the local press, viewed as driven by misguided racial loyalty; they fought back, struggling to send the message, Why close the hospital instead of fixing it? But in spite of mass mobilizations, it was closed down.

After Mark Ridley-Thomas was elected county supervisor in 2008, he led the charge to use public funds and leverage private funds to rebuild a smaller version of the Martin Luther King Jr. Multi-Service Ambulatory Care Center, to open in 2013 as part of a comprehensive plan to develop the area, and sought to go back to the unfulfilled post-Watts plans to redevelop the neighborhood, in conjunction with the UC. So what are the lessons learned? This is not an isolated story. The past few years have seen the closing of D.C. General and Philadelphia General, the destruction of Charity Hospital in New Orleans, and serious threats to Grady Memorial in Atlanta. The structural context is the same as that in which King/Drew happened, down to the same racist response in the press. The project is about struggles over urban space, redevelopment, and health concerns. The struggle over King/Drew represents victory, inasmuch as the activists changed the discourse and promulgated their vision of what these deindustrialized and privatizing urban spaces should become; but it also shows the resilience of central neoliberal power.

Pilgrim remarked that Bliss had challenged a lot of her beliefs. She noted that all three panelists had asked how we achieve health equality in an ethical and just manner. She asked Nelson, What can we learn from the Panthers’ approach? How can we reconcile the call for equality with the mistrust of the medical establishment? She asked Bliss, how do we reconcile the “unbiased” ideal of science with the kind of “activism” you described, where what gets funded is based on fashions? And how can we move away from race categories when certain inequalities are race-based?

Julie Elman, an NTT at Columbia, offered a question from a Disability Studies perspective about the reification and stigmatization of the diseased/disabled body. Bliss agrees that you need the category of disability, and the problems that category creates, to be recognized and noted that “These questions are not being asked within the realm of science that I study.” Nelson assured Elman that health for the Party was not about static categories of disease and illness; it was about needs and how your community and your ecology address your needs. She noted that she was not a disability scholar and recommended Sue Schweik’s recent piece about the Panthers and disability activism. A former Panther, impressed by mention of the “Five Dollar Sick” and Greene’s work on the hardships of transportation for the black community, expressed concern that the PPACA might divert NGO and community center funding to insurance companies and agreed with Nelson that we need more stories about agency and activism among black Americans. Greene replied that this issue is in many ways at odds with the national health care debate. It’s not about insurance, but how we get basic infrastructure when it’s drying up, and also accountability to the community.

An audience member asked how these movements got, or could get, out of a liberal model and more into biopolitics. Sickle-less anemia is a less stigmatized illness. Are these movements just asking for more access to the system? Greene said the fact that so much energy was spent demonizing these activists shows that they were onto something, and indeed, folks were pushing back against the idea that their demands should be confined to their little part of town. The backlash suggested that their activism was calling attention to big national issues. Nelson replied to the questioner’s Why sickle-cell anemia? It’s a predominantly black disease; it’d received far less funding than comparable genetic diseases; it allowed the Party to name and shame health disparities in a very clear way. It gave them a good narrative that fit into their discourse about slavery and about colonialism. Now, they had a lot of competitors in making frames around sickle-cell anemia, including the Nixon administration and older black groups who didn’t have or want a narrative. But out of this moment came many black doctors and health care professionals who went on to become activists.

Allison Carey asked about health activism as party of a broader civil rights movement: do we see that as one that included disability activism and other calls for access? Nelson repeated that she was not a scholar of the “disability studies movement” and explained that the Panthers’ narrative was not about access but about protection. Another audience member asked, how is health care shaping a political/economic subjectivity? They demolished public housing to build King/Drew, after all. Bliss said the individual who buys genetic tests is the kind of citizen/subject created by the research. Nelson noted that the downside of the story is it gets black communities to constitute themselves as biomedical entities. It’s the Nikolas Rose story of biopolitics, or the Katrina story, inspired by people after Chernobyl who had to commodify their illness to get reparations from the state. Greene cited “Civic Estrangement” in post-Civil Rights activism. At the point where King/Drew first emerges, we almost have the right to health care, and the minorities are asking for a piece. How did we get to these neoliberal times when we see that as anachronistic?

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